Department of Anesthesia, Savonlinna Central Hospital, Savonlinna, Finland.
Curr Opin Anaesthesiol. 2011 Jun;24(3):235-41. doi: 10.1097/ACO.0b013e328345ad18.
Although millions of parturients profit from neuraxial analgesia for labor, there are far more of those who do not have this choice for one reason or another. They need alternative ways to relieve labor pain.
Paracervical block gives less efficient analgesia compared with single-shot spinal in a sample of multiparae at active labor but is associated with better umbilical artery pH. Use of a neurostimulator may increase success in pudendal block. It is possible to reduce nitrous oxide occupational exposure by a developed scavenging system. Intravenous remifentanil gives less efficient pain relief than epidural analgesia. The maternal satisfaction, however, may be comparable.
Paracervical block with modern technique is a viable option for selected cases. It is rapid and does not affect the course of labor, but its efficacy is only modest. Pudendal block can be used in the second stage of labor or for episiotomy tear repair and pain. Intravenous remifentanil is currently becoming an established method, although its safety is still an issue. Nitrous oxide is a useful method to be used alone or together with the other methods.
尽管数以百万计的产妇从分娩时的椎管内镇痛中获益，但仍有更多的产妇因各种原因无法选择这种方式。她们需要其他方法来缓解分娩疼痛。
在活跃分娩的多产妇样本中，与单次脊髓麻醉相比，宫颈旁阻滞的镇痛效果较差，但与脐动脉 pH 值较好相关。使用神经刺激器可能会增加阴部阻滞的成功率。开发的清除系统可减少一氧化二氮的职业暴露。静脉注射瑞芬太尼的止痛效果不如硬膜外镇痛，但产妇满意度可能相当。
采用现代技术的宫颈旁阻滞是某些情况下的可行选择。它起效迅速，不影响产程，但效果只是中等。阴部阻滞可用于第二产程或会阴切开术撕裂修复和疼痛。静脉注射瑞芬太尼目前已成为一种既定方法，但其安全性仍是一个问题。一氧化二氮是一种有用的方法，可以单独使用或与其他方法联合使用。
